HomeMy WebLinkAboutJones 1T •
cam® r`17-#'7'474,9,
y�t ' ��
Town Hall, 53095 Main Road
t VivA `„4 P.O. Box 1179
1
� ' Southold, New York 11971
JUDITH T.TERRY
TOWN CLERK = ®� Iii. FAX(516)765-1823
TELEPHONE(516)765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 1416-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner JONES, CLIFFORD AND ELEANOR
Mailing Address 1 P. O. BOX 1172
Mailing Address 2
City St Zip MATTITUCK NY 11952-0000
Property Address 1 CARDINAL DRIVE
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-298-9172
Tax Map No. section 115.00 block 5 lot 13.000
Cross Street BLOSSOM BEND
Date Of Last Pump Out 0/00/85
Issue Date: 3/15/90 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
t -
vwJfFICE OF THE TOWN CLERK c��FFO(,'�'' � )
Town of Southold 0�� Application No. 1 '-i J, 0
Judith T. Terry, Town Clerk 4.---A--:.. iTown Hall 53095 Main Road .--..s� $10.00 - Residential
P. O. Box 1179 Ln :: i�, $25.00 - Non-Residential
\Y i :i4-''iY'�e7c
Southold, New York 11971 O�� '� •��` •
Telephone j `A '
• (516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
•
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ M. in)
DATE •3 `51 el-0
. OWNER NAME: Ce,' /ae,e6le.P ÷ r,1 e'lt Li ex .. ) /1/t^° • •
OWNER MAILING ADDRESS: go, Al,),,, f/7 "Z—
`'?fr1r/f 4/ M.\/ //9}'
OWNER PROPERTY ADDRESS: C R40 (u 49-c, •Aerd€'
fry) A TT/ 'TUCK_ ,v Y //,cS 2_—
OWNER
OWNER TELEPHONE NUMBER: c/g.- 2 f 5' 772
TAX MAP NO. : Section feriftrffti7 Block Lot 13
CROSS STREET: Ness p rn lJc-'w..oR
TYPE OF SYSTEM: Septic Tank - New Existing
Cesspool New Existing NK
Residential V Non-Residential
DATE OF PREVIOUS PUMP-OUT: 0 , Or_.1r-=-4`&1-' J -3
LOCATION MAP: Must be attached hereto before permit may be issued.
(Locate building and system; give north arrow and feet
of distance, approximately, to building and closest road.)
%lignAkApplicant
RECEIVED BY: ' ` I'. ja,4____
'own Clerk's O - ice
DATE: IS/ 6/i0
Cittg
ro
•
ea iv
N
1o7 33'
AN> 'TGx fs1�%s
c.O..re iv c--Y
co i®)t / 172_
rv‘/
Il?!?"L-